Oral lesions and monkeypox: increasing the need for prevention and access of a novel zoonotic disease – correspondence
Authors: Madhavan Yasasve, Saravanan Muthupandian, Tsehaye A. Dejene
Journal: International Journal of Surgery (2023)

Dear Editor: Monkeypox (MPOX), a novel zoonotic pox disease is a transmissible viral illness caused by the monkeypox virus that was first observed in humans in the 1970s. MPOX outbreaks have been documented in several countries, with the majority of cases restricted to endemic regions on the African continent1. However, the quick appearance of MPOX in a number of cities beyond the virus's endemic territory in persons who were not necessarily connected or who had not gone to Africa, as well as new data showing human-to-human transmission, caused too much alarm for many health authorities2,3. The current MPOX epidemic has been classified as a public health emergency of international concern by the World Health Organization (WHO)4. An intense fever sickness with many skin lesions is the characteristic clinical presentation of newly developed MPOX. MPOX has a 1–2 weeks incubation period, although it can be as brief as 7–20 days on the face before spreading to other sections of the body5. Patients and doctors are concerned when a lesion in the mouth is discovered because a small number of instances can be caused by cancer or hazardous diseases. But, MPOX symptoms include mouth ulcers and oral lesions6. Mouth ulcers can impair a person's ability to eat and drink, resulting in dehydration and malnutrition7. The latest MPOX epidemic originated with perioral papules that blistered and ulcerated. According to one research, over a quarter (24%) of MPOX patients had mouth ulcers. As a result, dentists in disease-endemic areas may be the first to notice MPOX precursor symptoms2,6. As a result, dental professionals working in locations where common or endemic illnesses are prevalent should exercise extreme caution, especially when examining patients with lymphadenopathy. In all patients, a thorough examination of the oral mucosa for macular and papular lesions is required. In healthy individuals, oral or cutaneous lesions emerge ~2 weeks after contact with the monkeypox virus while serum antibodies are often identified8,9. Since oral and perioral lesions are among the first to appear, the Oral Health Confraternity can help with case detection. Similarly, Indiana Dental Association (IDA) has issued an instructional brochure outlining the oral signs of monkeypox virus infection as well as the testing techniques that dentists can use to examine the virus in suspected patients10. Indeed, prior published research has revealed that oral ulcers were observed in infected patients during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 infection, emphasizing the necessity of dental health screening11. A lesion in the mouth might become the predominant issue, resulting in an oral sore that is readily neglected. At this level, just one intraoral lesion in the oral cavity, tongue, or oropharynx should be considered and evaluated. In conclusion, the initial sign may be mouth sores, which may be the first indication of MPOX. All patients with unexplained oral sores need the most advanced diagnostic and treatment options. This would aid not only in quick containment but also in providing better medical treatment. Following reports of the monkeypox virus community spread, it is critical to enhance health vigilance in risk groups through clinical prediction, focused testing, and vulnerable population education. Ethical approval Not applicable as no animal study was conducted. Sources of funding No funding. Author contribution T.A.D.: conceptualization, data curation, writing – original draft preparation. M.Y.: data curation, writing – original draft preparation. M.S.: conceptualization, writing – reviewing and editing, visualization and supervision. Conflicts of interest Authors declare that they have no conflicts of interest. Research registration unique identifying number (UIN) None. Guarantor Tsehaye Asmelash Dejene. Data statement All data are available in the manuscript. Provenance and peer review Not commissioned, internally peer-reviewed.